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Rawcliffe N, Elder D, Dobinson H. Time to first dose of antibiotics in febrile neonates. J Paediatr Child Health 2023; 59:718-722. [PMID: 36999339 DOI: 10.1111/jpc.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 04/01/2023]
Abstract
AIM To assess whether febrile neonates from the community received their first dose of intravenous antibiotics within 1 h from time of arrival, as per the regional paediatric sepsis pathway, at a tertiary combined adult/child emergency department in New Zealand. METHOD Retrospective data were collected from January 2018 to December 2019 with 28 patients included. RESULTS Mean time to first antibiotic dose for all neonates and those with serious bacterial infection was 3 h 20 min and 2 h 53 min respectively. No case used the paediatric sepsis pathway. A pathogen was identified in 19/28 (67%) neonates and 16/28 (57%) had clinical signs of shock. CONCLUSION This study adds to Australasian data on community neonatal sepsis. Antibiotic administration was delayed for neonates with serious bacterial infection, clinical signs of shock and raised lactate. The reasons for delay are examined, with a number of potential areas for improvement identified.
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Affiliation(s)
- Nicholas Rawcliffe
- Te Wao Nui Child Health, Capital Coast and Hutt Valley District Health, Wellington, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Hazel Dobinson
- Te Wao Nui Child Health, Capital Coast and Hutt Valley District Health, Wellington, New Zealand
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Topić Božič J, Butinar L, Ćurko N, Kovačević Ganić K, Mozetič Vodopivec B, Korte D, Franko M. Implementation of high performance liquid chromatography coupled to thermal lens spectrometry (HPLC-TLS) for quantification of pyranoanthocyanins during fermentation of Pinot Noir grapes. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-3005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Early Blood Biomarkers to Improve Sepsis/Bacteremia Diagnostics in Pediatric Emergency Settings. ACTA ACUST UNITED AC 2019; 55:medicina55040099. [PMID: 30974881 PMCID: PMC6524067 DOI: 10.3390/medicina55040099] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Background: Sepsis is the leading cause of death in children worldwide. Early recognition and treatment are essential for preventing progression to lethal outcomes. CRP and Complete Blood Count (CBC) are the initial preferred tests to distinguish between bacterial and viral infections. Specific early diagnostic markers are still missing. Aim: To investigate diagnostic value of Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet-MPV ratio (PLT/MPV) to distinguish sepsis/bacteremia and viral infection. Methods: We conducted a retrospective data analysis of case records of 115 children from 1 month to 5 years of age. All cases were divided into two groups-sepsis/bacteremia (n = 68) and viral (n = 47) patients, and further subdivided according to the time of arrival into early or late (≤12 or 12-48 h post the onset of fever, respectively). Analysis of CBC and CRP results was performed. NLR and PLT/MPV were calculated. Results: Sepsis/bacteremia group demonstrated higher absolute platelets count (370.15 ± 134.65 × 10⁸/L versus 288.91 ± 107.14 × 10⁸/L; p = 0.001), NLR (2.69 ± 2.03 versus 1.83 ± 1.70; p = 0.006), and PLT/MPV (41.42 ± 15.86 versus 33.45 ± 17.97; p = 0.001). PLT/MPV was increased in early arrival sepsis/bacteremia infants (42.70 ± 8.57 versus 31.01 ± 8.21; p = 0.008). NLR and MPV were significantly lower in infants (≤12 months) with viral infection on late arrival (1.16 ± 1.06 versus 1.90 ± 1.25, p = 0.025 for NLR and 8.94 ± 0.95fl versus 9.44 ± 0.85fl, p = 0.046 for MPV). Conclusion: Together with standard blood biomarkers, such as CRP, neutrophils, or platelets count, PLT/MPV is a promising biomarker for clinical practice to help discriminate between viral disease or sepsis/bacteremia in all children, especially in early onset of symptoms. NLR and MPV could support exclusion of sepsis/bacteremia in late arrival cases.
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Occult bacteremia etiology following the introduction of 13-valent pneumococcal conjugate vaccine: a multicenter study in Spain. Eur J Clin Microbiol Infect Dis 2018; 37:1449-1455. [PMID: 29736610 DOI: 10.1007/s10096-018-3270-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
Little is known about occult bacteremia (OB) in Spain following the introduction of the 13-valent pneumococcal conjugated vaccine (PCV13). Our aim was to describe the microbiologic characteristics and management of OB among children aged 3-36 months in Spain in the era of PCV13. Data were obtained from a multicenter registry of positive blood cultures collected at 22 Spanish emergency departments (ED). Positive blood cultures performed on patients aged 3-36 months from 2011 to 2015 were retrospectively identified. Immunocompetent infants with a final diagnosis of OB were included. Non-well-appearing patients and patients with fever > 72 h were excluded. We analyzed 67 cases (median age 12.5 months [IQR 8.7-19.4]). Thirty-seven (54.4%) had received ≥ 1 dose of PCV. Overall, 47 (70.1%) were initially managed as outpatients (38.3% of them with antibiotic treatment). Phone contact was established with 43 (91.5%) of them after receiving the blood culture result and 11 (23.4%) were hospitalized with parenteral antibiotic. All patients did well. Streptococcus pneumoniae was isolated in 79.1% of the patients (42.2% of the isolated serotypes were included in the PCV13). S. pneumoniae remains the first cause of OB in patients attended in the ED, mainly with non-PCV13 serotypes. Most of the patients with OB were initially managed as outpatients with no adverse outcome.
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Core curriculum illustration: necrotizing pneumonia and empyema. Emerg Radiol 2016; 23:201-2. [DOI: 10.1007/s10140-016-1379-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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Sharif MR, Haji Rezaei M, Aalinezhad M, Sarami G, Rangraz M. Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27932. [PMID: 26889398 PMCID: PMC4753024 DOI: 10.5812/ircmj.27932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/01/2015] [Accepted: 07/28/2015] [Indexed: 01/03/2023]
Abstract
Background Fever is the most common complaint in pediatric medicine and its treatment is
recommended in some situations. Paracetamol is the most common antipyretic drug, which
has serious side effects such as toxicity along with its positive effects. Diclofenac is
one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received
little attention as an antipyretic drug. Objectives This study was designed to compare the antipyretic effectiveness of the rectal form of
Paracetamol and Diclofenac. Patients and Methods This double-blind controlled clinical trial was conducted on 80 children aged six
months to six years old. One group was treated with rectal Paracetamol suppositories at
15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal
administration (n = 40). Rectal temperature was measured before and one hour after the
intervention. Temperature changes in the two groups were compared. Results The average rectal temperature in the Paracetamol group was 39.6 ± 1.13°C,
and 39.82 ± 1.07°C in the Diclofenac group (P = 0.37). The average rectal
temperature, one hour after the intervention, in the Paracetamol and the Diclofenac
group was 38.39 ± 0.89°C and 38.95 ± 1.09°C, respectively (P =
0.02). Average temperature changes were 0.65 ± 0.17°C in the Paracetamol group
and 1.73 ± 0.69°C in the Diclofenac group (P < 0.001). Conclusions In the first one hour, Diclofenac suppository is able to control the fever more
efficient than Paracetamol suppositories.
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Affiliation(s)
- Mohammad Reza Sharif
- Autoimmune Diseases Research Center, Kashan University of
Medical Sciences, Kashan, IR Iran
- Trauma Research Center, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Mostafa Haji Rezaei
- Trauma Research Center, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Marzieh Aalinezhad
- Department of Radiology, Isfahan University of Medical
Sciences, Isfahan, IR Iran
- Medical Student Research Center, Isfahan University of
Medical Sciences, Isfahan, IR Iran
| | - Golbahareh Sarami
- Department of Pediatrcis, Kashan University of Medical
Sciences, Kashan, IR Iran
| | - Masoud Rangraz
- Department of Pediatrcis, Kashan University of Medical
Sciences, Kashan, IR Iran
- Corresponding Author: Masoud Rangraz, Department of
Pediatrcis, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021,
Fax: +98-3155540111, E-mail:
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Vanguru L, Redfern RE, Wanjiku S, Sunallah R, Mukundan D, Vemuru L. Comparison of pediatric and general emergency medicine practice patterns in infants with fever. Clin Pediatr (Phila) 2015; 54:257-63. [PMID: 25269452 DOI: 10.1177/0009922814551133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate and compare the management approaches of pediatric and general emergency medicine physicians in infants presenting to the emergency department (ED) with complaint of fever. METHODS Infants 90 days of age or younger with a chief complaint of fever were included for review. Vital signs, laboratory workup, disposition, and final diagnosis were collected. Compliance with guidelines was assessed and compared between EDs. RESULTS Compliance with admission guidelines was not significantly different in any of the 3 age groups evaluated between the pediatric and general ED (PED and GED). Compliance with guideline recommendations for laboratory workup was not significantly different between the 2 EDs, nor was overall compliance with guideline recommendations. CONCLUSIONS No significant variations in the management of febrile infants or compliance with published guidelines between PED and GED physicians were observed. Young infants can be safely treated for fever in the PED or GED.
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Affiliation(s)
| | | | | | - Rami Sunallah
- Children's of Alabama Hospital, University of Alabama, Birmingham, AL, USA
| | - Deepa Mukundan
- The University of Toledo College of Medicine, Toledo, OH, USA
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Launay E, Morfouace M, Deneux-Tharaux C, Gras le-Guen C, Ravaud P, Chalumeau M. Quality of reporting of studies evaluating time to diagnosis: a systematic review in paediatrics. Arch Dis Child 2014; 99:244-50. [PMID: 24265414 DOI: 10.1136/archdischild-2013-304778] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE An ever-increasing number of studies analyses the distribution, determinants and consequences of time to diagnosis and delays. Weaknesses in their reporting can impede the assessment of the risks of bias and variation and thus create a risk of invalid conclusions and counterproductive clinical and public health efforts. This study sought to assess systematically the quality of reporting of articles about time to diagnosis in paediatrics. DESIGN Two authors identified and analysed the quality of reporting of 50 consecutive articles assessing these intervals published from 2005 through October 2011, according to a checklist we developed of 35 items potentially associated with risks of bias and variation. MAIN OUTCOME MEASURE Frequency of articles reporting each item. RESULTS Symptoms that should trigger a diagnostic procedure were reported in 28% of the articles; only two articles reported whether all patients with these symptoms underwent that procedure. Only 44% of the articles defined the beginning of the illness, 46% the date of diagnosis and 60% the distribution of time to diagnosis. Two studies met the criteria for all 11 items considered essential for assessing the risks of bias and variation in this type of study. INTERPRETATION This study identified many weaknesses in the quality of reporting of studies of time to diagnosis in paediatrics, especially for items potentially related to risks of bias and variation. This finding underlines the need for the development of new (or the refinement of existing) guidelines for reporting this type of study.
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Affiliation(s)
- Elise Launay
- Unité Inserm 953, Maternité Port-Royal, , Paris, France
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Abstract
Fever is the most common reason that children and infants are brought to emergency departments. Emergency physicians face the challenge of quickly distinguishing benign from life-threatening conditions. The management of fever in children is guided by the patient's age, immunization status, and immune status as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views. In this article, the evaluation and treatment of children with fevers of known and unknown origin are described. Causes of common and dangerous conditions that include fever in their manifestation are also discussed.
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Affiliation(s)
- Robyn Wing
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Abstract
PURPOSE OF REVIEW We review recommendations from recent publications on the management of fever with antipyretics, the classification and diagnosis of fevers of unknown origin (FUO), and the evaluation of fever in infants under 90 days of age. RECENT FINDINGS Anxiety about fever persists in the population, while the toxicity of antipyretics is an increasing concern. The numerous opportunities for overdosing with antipyretics have been emphasized by the American Academy of Pediatrics (AAP). The practice of alternating acetaminophen and ibuprofen has limited value. Nonclassic FUO and pseudo-FUO are as important to consider as true FUO, and clinicians should become familiar with the variety of periodic fever syndromes. The clinical utility of low-risk criteria to identify febrile infants at low risk for serious bacterial infection (SBI) was demonstrated in a systematic review of studies. SUMMARY Pediatricians should spend more time educating parents about fever and antipyretic use. Not all persistent fever is FUO, and testing should be targeted to the child's clinical condition. Existing low-risk criteria should be used to identify febrile infants who can be managed without extensive work-up and antibiotics. Adherence to evidence-based recommendations will lessen the morbidity and mortality associated with febrile illnesses in children.
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Kennebeck SS, Timm NL, Kurowski EM, Byczkowski TL, Reeves SD. The association of emergency department crowding and time to antibiotics in febrile neonates. Acad Emerg Med 2011; 18:1380-5. [PMID: 22168202 DOI: 10.1111/j.1553-2712.2011.01221.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The objective was to assess the relationship between emergency department (ED) crowding and timeliness of antibiotic administration to neonates presenting with fever in a pediatric ED. METHODS This was a retrospective cohort study of febrile neonates (aged 0-30 days) evaluated for serious bacterial infections (SBIs) in a pediatric ED from January 2006 to January 2008. General linear models were used to evaluate the association of five measures of ED crowding with timeliness of antibiotic administration, controlling for patient characteristics. A secondary analysis was conducted to determine which part of the ED visit for this population was most affected by crowding. RESULTS A total of 190 patients met inclusion criteria. Mean time to first antibiotic was 181.7 minutes (range = 18-397 minutes). At the time of case presentation, the number of patients waiting in the waiting area, total number of hours spent in the ED by current ED patients, number of ED patients awaiting admission, and hourly boarding time were all positively associated with longer times to antibiotic. The time from patient arrival to room placement exhibited the strongest association with measures of crowding. CONCLUSIONS Emergency department crowding is associated with delays in antibiotic administration to the febrile neonate despite rapid recognition of this patient population as a high-risk group. Each component of ED crowding, in terms of input, throughput, and output factors, was associated with delays. Further work is required to develop processes that foster a more rapid treatment protocol for these high-risk patients, regardless of ED crowding pressures.
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Affiliation(s)
- Stephanie Spellman Kennebeck
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH, USA.
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